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. 2024 Aug;281(8):4191-4199.
doi: 10.1007/s00405-024-08695-w. Epub 2024 May 3.

Association of mucus eosinophil-derived neurotoxin levels with disease control status in patients with chronic rhinosinusitis

Xiaoxi Huang  1 , Zheng Liu  1 , Benjamin S Bleier  2 , Yu Song  3   4 , Dawei Wu  5
Affiliations

Association of mucus eosinophil-derived neurotoxin levels with disease control status in patients with chronic rhinosinusitis

Xiaoxi Huang et al. Eur Arch Otorhinolaryngol. 2024 Aug.

Abstract

Objective: Identifying the biomarkers for uncontrolled chronic rhinosinusitis (CRS) is important for directing treatment decisions. Eosinophilia has been reported to be involved in the poor disease control of CRS and mucus eosinophil-derived neurotoxin (EDN) is potentially a biomarker of intense eosinophil activation. This study aimed to assess the relationship between mucus EDN levels, disease severity, and degree of CRS control.

Methods: A total of 150 adult patients with CRS and 25 healthy controls were prospectively enrolled. The nasal mucus and tissue specimens were collected to analyze EDN levels. Disease severity was assessed by Lund-Mackay score and 22-item Sino-Nasal Outcome Test (SNOT-22) score. Five CRS symptom severities during the prior month (nasal blockage, rhinorrhoea/postnasal drip, facial pain/pressure, smell, sleep disturbance or fatigue), use of rescue medications in the last six months, and the presence of diseased mucosa on nasal endoscopy were obtained. Consistent with the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 CRS control criteria, uncontrolled CRS was defined as meeting at least three items.

Results: 40% of patients with CRS presented with uncontrolled status. Patients with uncontrolled CRS had significantly higher nasal mucus EDN levels (P = 0.010), percentage of blood eosinophil (P = 0.015), SNOT-22 score (P < 0.001), Lund-Mackay score (P = 0.008), and a more eosinophilic dominant phenotype of CRS (P < 0.001) than patients with controlled CRS. Furthermore, mucus EDN levels were positively correlated with blood eosinophils (r = 0.541, P = 0.005), SNOT-22 score (r = 0.460, P = 0.021), and Lund-Mackay score (r = 0.387, P = 0.039). Mucus EDN levels were the significant parameter related to uncontrolled CRS in multivariable analysis after adjusting for patient demographics and comorbidities (odds ratio = 1.323; P = 0.004).

Conclusions: Mucus EDN levels may be a potential biomarker for identifying the CRS control status.

Keywords: Biomarkers; Chronic rhinosinusitis; Disease control; Eosinophil-derived neurotoxin; Nasal mucus; Predictor.

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